Long-Term Anatomical and Functional Outcomes Following Laparoscopic Repair of Severe Cesarean Scar Defect.

Abstract

Study objective: To assess the long-term anatomical and functional effectiveness of laparoscopic repair for severe cesarean scar defect (CSD), focusing on residual myometrial thickness (RMT), symptom resolution, recurrence rates, and reproductive outcomes.

Design: Retrospective observational study.

Setting: Single-center tertiary hospital.

Patients: Thirty-three women diagnosed with severe CSD, defined as RMT < 2.5 mm, who underwent laparoscopic surgical repair between November 2008 and January 2021.

Interventions: Laparoscopic repair of severe CSD with the aim of restoring uterine integrity and improving clinical and reproductive outcomes.

Measurements and main results: RMT was assessed preoperatively, at three months post-surgery, and then annually via transvaginal ultrasound. Primary and secondary outcomes included postoperative RMT changes, CSD repair failure rate, severe CSD recurrence, symptom resolution, and reproductive outcomes. Postoperative RMT significantly increased from a median of 1.0 mm (0 - 2.3) preoperatively to 5.0 mm (1.0 - 9.0) at three months (p<.00001) and remained stable during follow-up (median: 6.4 years, range: 2.0 - 14.2). Symptom resolution rates were 90.9% for abnormal bleeding and 100% for pelvic pain within one year. One patient (3.0%) experienced CSD repair failure. Severe CSD recurrence was observed in one case (3.0%). Among 24 patients attempting pregnancy, 79.2% conceived, with 62.5% achieving live births. No cases of uterine rupture or severe obstetric complications occurred. Severe CSD recurrence after a subsequent cesarean delivery was noted in 6.7% (1/15).

Conclusion: Laparoscopic repair of severe CSD provides durable anatomical restoration, significant symptom relief, and favorable reproductive outcomes with low recurrence rates over long-term follow-up.